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6: Bleaching Techniques

Introduction: Whiter or brighter smile, which is a cornerstone of a beautiful esthetic smile, can be achieved by bleaching. The public concern about appearance has been partly responsible for increased awareness in esthetic dentistry and consequently bleaching techniques. Bleaching solutions have been reported to cause alterations and loss of mineral content in surface enamel after bleaching.

These irregularities in enamel surface could result in more susceptibility to re-pigmentation, thereby adversely affecting the whitening treatment. Aim: To evaluate the susceptibility of teeth to re-pigmentation using two different bleaching materials, i. Subjects and Methods : In this study, 30 extracted teeth were divided in three groups.


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They were then stained with silver nitrate stain to evaluate their susceptibility to pigmentation after bleaching. The shade of each tooth was recorded before bleaching, after bleaching, and after pigmentation using a Vita shade guide.

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Results: Results showed that after staining with silver nitrate, the teeth in all groups became darker but the amount of change in the shade value of the samples was different for the two groups. Conclusions : Thus, we concluded that susceptibility to pigmentation increases after bleaching. Furthermore, pigmentation is greater when H 2 O 2 is used for bleaching. Users Online: Susceptibility of teeth to re-pigmentation after bleaching: An in vitro study.

J Res Dent ; Figure 1: After staining with silver nitrate, the teeth in all groups became darker. But the amount of change in the shade value of the samples was different for the two groups. Table 1: Shade and their values Click here to view. Figure 4: a Shades registered after bleaching using Vita shade guide, b Shades registered after bleaching using Vita shade guide Click here to view.

Figure 5: a Shades registered after pigmentation using Vita shade guide, b Shades registered after pigmentation using Vita shade guide Click here to view. Figure 6: Graphical representation of the results obtained showing that tendency of pigmentation increases after bleaching. Table 2: Mean shade values before and after pigmentation Click here to view. Greenwall L. Thieme Medical Pub; 1 St Edition edition; Effect of hydrogen peroxide and sodium perborate on the micro hardness of human enamel and dentine. J Endod ; Monitoring of demineralized dentin microhardness throughout and after bleaching.

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Am J Dent ; Pesqui Odontol Bras ; The effects of seven carbamide peroxide bleaching agents on enamel microhardness over time. Conclusion: The combined bleaching technique using at-home bleaching associated with in-office bleaching was effective and stable over the course of 12 months, regardless of the concentration of the hydrogen peroxide used for in-office bleaching. Based on preestablished criteria, 30 volunteers seeking dental bleaching were selected for this study. Two weeks before the bleaching procedures, all volunteers received dental prophylaxis with pumice and water in a rubber cup and signed an informed consent form.

The Effect of Remineralizing Agents on Tooth Color after Home Bleaching

All participants were instructed to brush their teeth regularly using fluoridated toothpaste without hydrogen peroxide. Within this context, and in an attempt to decrease the number of in-office bleaching sessions, some authors have proposed the combined bleaching technique. This study was a randomized, parallel, and singleblind clinical trial with an equal allocation rate between groups. Eligibility Criteria Patients included in this clinical trial were at least 18 years old and had good general and oral health.

Patients were excluded from the study if they had undergone previous teeth-whitening procedures or had anterior teeth with restorations on the labial surfaces, veneers or full crowns, gingival recession on anterior teeth, spontaneous tooth pain, endodontically treated anterior teeth, fluorosis, severe internal tooth discoloration, teeth with noncarious. Carbamide peroxide, neutralized carbopol, potassium nitrate, sodium fluoride, humectant glycol , deionized water.

Random Sequence Generation and Allocation Concealment The randomization process was performed by coin toss immediately before the bleaching procedure to provide adequate allocation concealment. Details of the composition, mode of applica-. Mode of Application 1. Attach the hydrogen peroxide syringe in the other side of the attachment appliance.

Keep the set ready for mixture soon before application. Mix the contents of both phases by alternately pressing the plungers of the syringes in opposite directions up to eight times. Press the entire mixture content into one of the syringes. Application of minutes and a single application are done at each clinical appointment.

Dental bleaching | British Dental Journal

Press the syringe plunger and apply the bleaching gel into the dental tray. The small drop per tooth is sufficient to cover the teeth. Place the tray on the teeth and press lightly so that the gel is distributed all over the dental surface. Remove the excess gel with a finger or toothbrush. Use the gel for two hours. Wash the tray well before storing it and using it.

The in-office bleaching gel was then applied in a single minute session. The patients were instructed to load the bleaching tray with the gel and wear it for two hours daily over the course of two weeks.

In the event of disagreement between the examiners during shade evaluation, a consensus was reached. Color evaluation was not performed immediately after the in-office bleaching session to avoid the effect of dehydration and demineralization on color measures.


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The color evaluation was performed with the value-oriented shade guide Vita Classical Vita Classical, Vita Zahnfabrik. The 16 tabs of the shade. Although this scale is not linear in the truest sense, for the purpose of analysis, the changes were treated as though they represented a continuous and approximately linear ranking, as performed in most studies on dental bleaching.

Color changes were calculated from the beginning of the active phase through the individual recall times by calculating the change in the number of shade guide units DSGU that occurred toward the lighter end of the value-oriented list of shade tabs. Tooth Sensitivity Evaluation TS was evaluated at baseline, during in-office bleaching, up to 48 hours after in-office bleaching, and daily during the two weeks of at-home dental bleaching.

If the patient selected zero no TS for all the assessments, this patient was considered to be insensitive to the bleaching protocol.

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In all other circumstances, the patients were considered to have sensitivity to the bleaching procedure. This dichotomization allowed us to calculate the absolute risk of TS, which represents the percentage of patients who reported TS at least once during the treatment. We also calculated the overall TS intensity based on the worst score of pain reported by the patient in the different assessments.

The data sets were plotted on histograms and inspected for normal distributions. Some data did not appear to be normally distributed and, therefore, nonparametric statistical tests were used to compare the various treatments.